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Operation Helps Men Urinate Like Teenagers

ByDr. Gifford Jones

What should men and their wives know about the New Gold Standard? No, not the one associated with the London England Gold Market. Rather, the new gold standard of treating benign prostatic hypertrophy (BPH) in men. A report from The Mayo Clinic in Rochester, Minnesota, is good news for hundreds of thousands of males who every year require surgery for this condition. And who worry that it may affect their sexual health.

Normally, during male urination, the size of the stream is about one-quarter of an inch. But as men age the prostate gland enlarges and squeezes the urinary tube. Its size may decrease to one-sixteenth of an inch. And if it reaches zero it obviously requires emergency surgery.

For years the gold standard of treatment has been a transurethral resection of the prostate gland (TURP). In effect, it’s a reaming out of prostate tissue to allow easier passage of urine. This operation normally provides good results but occasionally results in urinary incontinence. It also disturbs some men that following a TURP sexual intercourse causes “reverse ejaculation” in which the semen flows backwards into the urinary bladder rather than out through the penis. Moreover, in some cases a TURP results in impotence.

Dr. Reza Malak, Professor Emeritus at The Mayo Clinic, recently reported on a treatment called photoselective vaporization of the prostate (PVP) to the recent meeting of the Canadian Urology Association. PVP is simply a different way to remove excess prostate tissue, by using a high-powered laser beam to vaporize tissue rather than a cutting instrument.

PVP involves inserting a thin fiber into the urinary tube through a cystoscope by which laser energy destroys excessive prostate tissue. The procedure takes about 45 minutes.

Dr. Malek explained that there are several advantages to PVP. A major difference is that the operation is almost bloodless. Also significant is reduced post-operative pain. And there has not been a single case of either urinary incontinence or impotence. Dr. Malek adds “These men urinate like teenagers.”

PVP also helps to prevent “retrograde ejaculation” which occurs in 90 per cent of sexually active men following TURP. Following PVP surgery, retrograde ejaculation occurred only in 26 per cent of patients.

Patients were generally pleased, reporting an 80 per cent reduction in symptoms and a 170 to 250 per cent increase in urinary flow. In addition, there was immediate restoration of normal urine flow, prostate symptoms were resolved quickly and 50 per cent of patients did not require a catheter. But when a catheter was required initially, it could be removed the next morning.

PVP is also a time-saver. The operation can be done on an out-patient basis and patients can usually return to work in two days, except those engaged in heavy manual labour. Patients have been followed now for five years, and so far no patient has required a second operation.

Dr. Malek cited another advantage. Today many elderly males who require an operation for BPH are taking anti-coagulant medication such as Aspirin to prevent heart attack. These drugs have to be discontinued prior to prostate surgery to prevent excessive bleeding. But PVP can be done without stopping these drugs.

Dr. Edward Woods, a Toronto urologist at Scarborough General Hospital, is also enthusiastic about PVP. He states he has been able to perform PVP on patients who would otherwise not be suitable for any of the current procedures due to the size and fragility of the prostate gland.

The timing of surgery depends on the degree of blockage, severity of symptoms and the patient’s occupation. For instance, patients who have difficulty voiding usually have leftover urine in the bladder that results in frequent urination. This is a trying problem if you’re a neurosurgeon with operations lasting eight hours. Leftover urine, like a stagnant pond, can also cause recurrent urinary infections requiring surgery.

Don’t push your luck if the urinary stream decreases to one-sixteenth of an inch. This is often the lull before the storm, and if surgery is delayed complete blockage may occur requiring an emergency operation.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He’s been a ship’s surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: http://www.mydoctor.ca/gifford-jones

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